Pelvic floor reconstruction with a biological mesh is a feasible solution when performing ELAPE for low rectal cancer, although long-term pain is a frequent complication.

Pancreatic SRCC is a rare, aggressive tumor. Given limited evidence and the risk of side effects, physicians may elect to withhold chemotherapy in select patients, with the exception of neoadjuvant chemotherapy use to facilitate resectability.

Patients who underwent pancreatectomy frequently experienced an improvement in preoperative symptoms, but also experienced new postoperative symptoms. This was more common after Whipple operations. However, these symptoms were relatively mild in severity. These mild symptoms seem to persist over time.

BackgroundAfghanistan has struggled with several decades of well-documented conflict, increasing the importance of providing emergency services to its citizens. However, little is known about the country’s capacity to provide such care.MethodsThree native-speaking Afghan-American physicians performed an assessment of emergency care via combined quantitative and qualitative survey tools. Hospitals in Kabul, Afghanistan were selected based on probability proportional to size methodology, in which size was derived from prior work in the country and permission granted by the administering agency and the Ministry of Health. A written survey was given to physicians and nurses, followed by structured focus groups, and multiple days of observation per facility. A descriptive analysis was performed and data analyzed through a combination of variables in eight overarching categories relevant to emergency care.ResultsOne hundred twenty-five surveys were completed from 9 hospitals. One third of respondents (32.8 %) worked full time in the emergency departments, with another 28.8 % working there at least three quarters of the time. Over 63 % of providers believed that the greatest delay for care in emergencies was in the prehospital setting. Differences were noted among the various types of facilities when looking at specific components of emergency care such as skill level of workers, frequencies of assaults in the hospitals, and other domains of service provision. Sum of squares between the different facility types were highest for areas of skill (SS = 210.3; p = .001), confidence in the system (SS = 156.5; p < .005), assault (SS = 487.6; p < .005), and feeling safe in the emergency departments (SS = 193.1, p < .005). Confidence negatively correlated to frequency of assaults (Pearson r = −.33; p < .005) but positively correlated with feeling safe (Pearson r = .51; p < .005) and reliability of equipment (Pearson r = .48; p < .005). The only correlation for access to services was prehospital care (Pearson r = .72, p < .005).ConclusionsThere is a significant need to provide emergency care services in Afghanistan, specifically prehospital care. High variability exists among facility-type in various components of emergency services provision.Electronic supplementary materialThe online version of this article (doi:10.1186/s12245-015-0069-0) contains supplementary material, which is available to authorized users.

5 Bebenek M. Abdominosacral amputation of the rectum for low rectal cancers: ten years of experience. Ann Surg Oncol 2009; 16: 2211-17. 6 Han JG, Wang ZJ, Wei GH et al. Randomized clinical trial of conventional versus cylindrical abdominoperineal resection for locally advanced lower rectal cancer. Am J Surg 2012; 204: 274-82.

Background: Pancreatectomy affects gastrointestinal (GI) symptoms. Our purpose was to assess the quality of life of pancreatectomy patients in relation to GI function. Methods: Pancreatectomy patients were asked qualitative, open-ended questions about symptoms. They also completed the Gastrointestinal Symptom Rating Scale (GSRS) for reflux syndrome, acute pain syndrome, indigestion syndrome, diarrhoea syndrome and constipation syndrome. Results: A total of 52 patients participated. Of these, 69% reported an improvement and 31% reported no change in preoperative symptoms. No patients reported a worsening of symptoms. Half (50%) of the patients experienced new, different symptoms. Median GSRS scores were 0 for reflux syndrome [interquartile range (IQR): 0-1.0], 0 for acute pain syndrome (IQR: 0-1.0), 2.0 for indigestion syndrome (IQR: 1.0-4.0), 2.0 for diarrhoea syndrome (IQR: 0.5-4.5), and 0 for constipation syndrome (IQR: 0-1.0). Whipple operation patients scored higher on the reflux syndrome (0.5 vs. 0; P = 0.08) and indigestion syndrome (3.5 vs. 1.5; P = 0.06) domains. A total of 68% of Whipple operation patients experienced new symptoms, compared with 32% of patients who had undergone other types of pancreatectomy (P = 0.002). Scores of patients who had undergone surgery <2 years and >2 years earlier, respectively, did not differ. Conclusions: Patients who underwent pancreatectomy frequently experienced an improvement in preoperative symptoms, but also experienced new postoperative symptoms. This was more common after Whipple operations. However, these symptoms were relatively mild in severity. These mild symptoms seem to persist over time.

Autism is a neurodevelopmental disorder marked by severe deficits in social communication and interactions. It is a complex condition that lacks an established preventive method, warranting a need for research to identify possible environmental triggers. The identification of external factors particularly perinatal risk factors forms the initial critical step in preventing and alleviating risks. We conducted a literature review to assess evidence suggested in the worldwide literature. Perinatal risk factors that have a suggested association include β2 adrenergic receptor agonists, labor induction and augmentation, maternal infection and disease (i.e., antiphospholipid syndrome), antiepileptic drugs, cocaine use, and oral supplements. Smoking has not been found to have a direct association. Pollutants, selective serotonin reuptake inhibitors, artificial insemination, and fertility medications may have a link, but results are often conflicted. Factors related to the delivery room experience may be associated with meconium aspiration syndrome, birth weight, and labor time. Several risk factors during the pregnancy and labor periods have been associated with autism; yet further studies with large populations are needed to establish definitive associations. The fact that several risk factors during the prenatal and labor periods are implicated in autism should prompt the medical community to focus on the pregnancy and labor periods as preventive measures to curb the incidence of autism.

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